Over three days, the annual pilgrimage of 25,000 rollicking concertgoers to the Sasquatch Music Festival turns central Washington's picturesque Gorge Amphitheater along the Columbia River into the largest city in Grant County.

But not all of them stay there. Some end up at the tiny hospital in Quincy, Washington, with drug overdoses, alcohol poisoning and dehydration.

Quincy is about 17 miles from the Gorge, past vineyards and alfalfa fields. Its small hospital sits down the street from a plant that turns potatoes into french fries. On a typical day, maybe 10 people will come through the doors.

But during the three-day Sasquatch festival? It's more like 60 or 70 per day.

And Sasquatch is just the beginning. Dietsch has a printout of all the Gorge summer concerts. With each new event, he’ll go online and listen to the music so he can predict what kind of crowd will be there and what kind of drugs will they use. Coming up in late June is Paradiso, a two-day electronic music festival. Then there's Watershed in August -- three days of country music.

For Paradiso, Dietsch says he's expecting a lot of synthetic narcotics. For Watershed, he says, "Mostly alcohol. Alcohol and fights.”

Dietsch admits that he is forced to stereotype "more than a little bit."

"We have to have a good understanding of what these concerts draw," he says. "And what staff we have to have here.”

Footing the bill

All those concerts are starting to take a toll. Most of those 20-somethings in flip-flops pay their hospital bills. But some don’t. And that, along with the additional staff that has to be scheduled around the Gorge concerts, cost the publicly-owned hospital $400,000 last year.

“This situation can no longer continue,“ hospital administrator Mehdi Merred says. “In our research, there was not a similar situation in the entire United States where a small, rural hospital has to take care of a large venue like the Gorge.”

There are other summer outdoor music festivals in small towns -- the Britt Festivals in Jacksonville, Oregon, the Festival at Sandpoint in north Idaho. But those don't attract nearly the size, nor the type of crowd that the Gorge Amphitheater does. Coachella is similar, but it's close to several California cities with hospitals. Burning Man contracts with a Winnemucca hospital to provide on-site emergency aid.

Merred is now making an unusual request. He's asking Live Nation, the company that produces all the Gorge concerts, to pay up. Merred says he met with Live Nation last summer after a 21-year-old man died at Paradiso. But he says so far they haven't been able to work out a deal.

“I seriously do not believe in their good faith at this point,” Merred says.

Live Nation declined to comment on tape, but in a written statement says, “We have met with the hospital and the Gorge continues to operate in close cooperation with local, state and federal officials.” A spokeswoman also noted that concerts are an economic driver in the region. Indeed, the county treasurer says last year, an admissions tax generated $1.2 million from the Gorge.

An added fee?

Recently, state Representative Matt Manweller, a Republican from the Ellensburg area, stepped in to try to find a solution. He is crafting a bill that would allow the county to add a $1 fee to concert tickets at the Gorge.

“I'm not sure that Live Nation is responsible for some of the bad decisions that their concertgoers make," Manweller says. "And by levying this fee on the ticket, it's the actual concertgoer who bears the cost. And I just think that's more fair.”

Half the money would go to the hospital district, the other half to the fire district, which has also been struggling to manage the strain of concert weekends.

Of course, the people who end up in the Quincy hospital are just a tiny sliver of the 250,000-plus concertgoers at the Gorge. Nick Emacio, a Seattle musician who has gone to Sasquatch four times since 2005, says most people are there to enjoy the music and camp out with their friends.

“You’ll see people having beers and everybody’s having a good time in their little groups and parties and things like that," he says. "But if you go up to the $20-a-day parking, it’s like ‘Mad Max: Beyond Thunderdome.’ Something’s on fire. Everybody’s running around, there’s somebody on a motorcycle or something. It’s insane.”

Emacio isn't going to Sasquatch this year. At over $300 a ticket, it's a little out of his price range at the moment. And maybe next year, that will be $301.

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The Sasquatch Music Festival kicks off Friday, May 23 at the Gorge Amphitheater and runs into the early hours of Monday morning.